脳卒中後嚥下障害の脱胃瘻の予測因子

脳卒中後嚥下障害の脱胃瘻の予測因子を検討した論文を紹介します。

Yi Y, Yang EJ, Kim J, Kim WJ, Min Y, Paik NJ. Predictive factors for removal of percutaneous endoscopic gastrostomy tube in post-stroke dysphagia. J Rehabil Med. 2012 Oct 2. doi: 10.2340/16501977-1050. [Epub ahead of print]

対象は脳卒中後嚥下障害で胃瘻造設した49人で、このうち8人が胃瘻を離脱しています。後ろ向きコホート研究で脱胃瘻できた群とできなかった群のデモグラフィック、栄養状態、チャールソンインデックス、PEG時のVF所見を比較しました。

結果ですが、脱胃瘻では、PEG時のVF所見で誤嚥や咽頭反射遅延（pharyngeal trigger delay）が有意に少なかったです。これより誤嚥や咽頭反射遅延は脱胃瘻の予測因子となる可能性があり、PEGの判断の補助になるという結論です。

抄録しか読んでいないので詳細不明ですが、VFで誤嚥や咽頭反射遅延がなくてもPEGを行うという基準というものがよくわかりません。そもそもPEGが不要だった可能性が低くない気がします。この程度の後ろ向きコホート研究でJ Rehabil Medに掲載されるということも驚きです。

Abstract

Objective: To investigate predictive factors for percutaneous endoscopic gastrostomy (PEG) removal, thereby minimizing unnecessary PEG insertion in post-stroke dysphagia. Design: Retrospective cohort study. Patients: A total of 49 patients who undertook PEG tube insertion for post-stroke dysphagia Methods: Patients were divided into a removal group (n = 8) and a sustaining group (n = 41) depending on the presence of a PEG tube. Patients' demographic data, nutritional status, Charlson's Comorbidity Index (CCI), and video-fluoroscopic swallowing study findings at the time of PEG insertion were compared between the 2 groups. Results: Eight out of 49 patients (16.3%) removed the PEG tube at a mean of 4.8 months after the insertion. Demographic data, nutritional status, and CCI were comparable between the 2 groups before tube insertion. Video-fluoroscopic swallowing study findings in the removal group showed a lower prevalence of premature bolus loss (50.0% vs 73.2%; p = 0.032), aspiration (37.5% vs 80.6%; p = 0.012) and pharyngeal trigger delay (12.5% vs 74.2%; p = 0.010) than those in the sustaining group. Conclusion: The absence of aspiration or pharyngeal trigger delay in video-fluoroscopic swallowing study findings at the time of PEG insertion may be a predictive factor for eventual removal of PEG tubes. Identification of removal factors will assist in determining PEG insertion.